Health care lead shifts

It’s been 13 months since Jim Flaherty winged his way to the West Coast, chowed down on some beef tenderloin with his provincial counterparts, then dropped his Victoria bombshell over lunch the next day.

Here’s your health-care funding until 2016-17, the federal finance minister said, six per cent increases until then, followed by increases tied to economic growth plus inflation. How it is spent is up to you.

There is nothing to negotiate, now where’s my hat, what’s my hurry?

A stunned Dwight Duncan, now the outgoing finance minister of Ontario, called the move by Ottawa a “frontal attack” on health care in Canada and said Flaherty had given the provinces a pre-Christmas lump of coal.

But lo and behold, after all the bluster, the cries that Ottawa had abdicated its health-care leadership duty, that we would see a “patchwork quilt” of different health-care systems in different provinces, the first step toward health-care reform has been cobbled together by the provinces.

A task force led by Saskatchewan Premier Brad Wall and Prince Edward Island Premier Robert Ghiz had found a way to save, they say, $100 million with a bulk buy of six generic drugs in this country.

A small first step, the two men say, and more savings will be coming.

But beyond $100 million in drug-costs savings, this was also a first step in health-care delivery in this country without the federal government leading the way.

It’s an act of ownership in the health-care system by those who deliver the care, the provinces.

Now Ottawa appears ready to piggyback on this drug deal after, as Ghiz puts it, the provinces did the “heavy lifting.”

There will be more, Ghiz has promised, with a meeting of health ministers tentatively set for March. This could include extending the bulk buying to brand-name drugs and bulk buying of medical equipment.

And they may also move on unnecessary medical testing.

But haven’t they just shown they can work without Ottawa; that they are doing exactly what Ottawa asked?

“We came together because we were ignored when it came to sitting down and negotiating future health-care programs with the federal government,” Ghiz said. “We were given a unilateral deal.

“Of course we want the feds at the table. We need them at the table when it comes to looking at new national programs or changing programs.

“The big reason we want to have the feds at the table — they have dollars. I am willing to listen to their suggestions if they are willing to put dollars on the table.”

The federal strategy was a major break with health-care delivery in this country carved out over almost five decades.

Until this government provided the no-strings-attached funding, previous federal governments had used the power of the purse to force recalcitrant provinces back into line if they strayed from the tenets of the Canada Health Act.

The battles between federal Liberal governments and Alberta under Ralph Klein are part of political lore in this country.

During one battle, Klein famously accused the Liberal health minister of the day, Allan Rock, of a “drive-by smear” after a Calgary speech.

Now Stephen Harper is saying to the premiers — go ahead, innovate and reform.

Harper told the CBC’s Peter Mansbridge, shortly after the Flaherty deal was sealed, that he was no longer going to blame the provinces for health-care problems or lead on innovation from the national capital.

“I think that’s been a better method than in the past trying to pretend there is some overarching national standards,” he said, “and then wave the finger at them for perceived slights. I don’t think that’s been effective.”

If nothing else, Harper pushed health-care battles off the front burner in this country.

There is nothing — not even moral imperative — that forces provinces to put these drug savings back into health care, but with health care eating up to 40 per cent of some provincial budgets, it is almost certain that’s where the bulk of the financial savings will go, Ghiz says.

Ottawa may yet have to take a lead when it comes to health-care reform or innovation.

But once Harper tossed the ball into the provincial court, the premiers really had no choice but to get this done themselves, and, so far, they are getting it done.

Tim Harper is a syndicated Toronto Star national affairs writer. He can be reached at tharper@thestar.ca.

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